Claims Manager

CorSource; Portland (OR); On-site; USD 110,000 - 140,000; Full time

Job summary

An established industry player is seeking a dynamic leader to manage their claims department. This role involves overseeing workflows, developing policies, and ensuring compliance with healthcare regulations. The successful candidate will lead a team, focusing on training and developing staff while enhancing customer service excellence. With a strong emphasis on process improvement and cross-functional collaboration, this position offers the opportunity to make a significant impact in a vital area of the organization. If you are passionate about healthcare and possess extensive claims management experience, this role is perfect for you.

Qualifications

• 8+ years of experience in health plan/carrier claims or customer service management.
• Strong knowledge of state and federal regulations related to claims administration.
• Experience with claims adjudication principles and procedures.
• Familiarity with medical terminology including CPT, HCPCS, and ICD-10 coding.
• Leadership experience, particularly training and developing staff.
• Comfort with technology, particularly claims processing systems.

Responsibilities

• Oversee workflows and develop policies to ensure compliance with regulations.
• Manage and train staff, particularly those without prior claims experience.
• Cross-functional Collaboration - Working closely with other departments on organizational initiatives and projects.
• Customer Service Excellence - Ensuring high-quality service to members, providers, and health plans.
• Process Improvement - Identifying opportunities to enhance efficiency, automation, and accuracy in claims processing.
• Compliance Management - Staying current with healthcare regulations and ensuring the department meets all requirements.

Skills

Customer Service Management

Claims Administration Knowledge

Leadership Skills

Regulatory Compliance

Claims Adjudication Principles

Medical Terminology

Technology Proficiency

Tools

Claims Processing Systems

Job description

Responsibilities

• Department Management - Overseeing workflows, developing policies and procedures, and ensuring compliance with regulations.
• Team Leadership - Managing, training, and developing staff, particularly those who may not have prior claims experience.
• Cross-functional Collaboration - Working closely with other departments on organizational initiatives and projects.
• Customer Service Excellence - Ensuring high-quality service to members, providers, and health plans.
• Process Improvement - Identifying opportunities to enhance efficiency, automation, and accuracy in claims processing.
• Compliance Management - Staying current with healthcare regulations and ensuring the department meets all requirements.

Qualifications

• 8+ years of experience in health plan/carrier claims or customer service management
• Strong knowledge of state and federal regulations related to claims administration
• Experience with claims adjudication principles and procedures
• Familiarity with medical terminology including CPT, HCPCS, and ICD-10 coding
• Leadership experience, particularly training and developing staff
• Comfort with technology, particularly claims processing systems

Seniority level

Mid-Senior level

Employment type

Full-time

Job function

Finance and Sales

Industries

IT Services and IT Consulting